Connective Tissue & Menopause

The menopause brings with it a range of physiological changes associated with the decline of female sex hormones, notably oestrogen and progesterone. While these two hormones are certainly not the only factors that affect change during this time, the sharp decline of oestrogen, in particular, has significant effects on tissues throughout the body for many women, including connective tissues (in particular bone, ligaments, and tendons).

In case you are unfamiliar with the term “Connective Tissue”, it is simply a collective name for tissue that connect, support, bind, or separates other tissues or organs. As you can deduce, your body contains a lot of connective tissue.

Understanding Collagen

The primary building block of connective tissue is the protein collagen, and in the same way that there are many forms of connective tissue equally there are different types of collagen. Our bodies manufacture collagen, but as we age this process slows and we produce less of it. I say “we” because this is true of both men and women. However this reduction is more marked in women and the greater drop seems to be associated with the reduction in oestrogen (which stimulates collagen production) found in post menopausal women. Collagen loss has been shown to be slowed in women who are receiving hormone replacement therapy.

It will be clear to you that a reduction in collagen production will have a pronounced effect on your bodies ability to regenerate connective tissue.

If we have an interest in maintaining good bone and joint health (which means we have an interest in remaining mobile, able to live our lives happily and avoiding the fracture clinic), then we need to take some proactive steps.


There is a thriving market around collagen supplementation. It appeals to the quick fix instinct and provides a subliminal comfort blanket. As with all quick fixes it leads us (dangerously) to not change any of our lifestyle habits to address the situation. The idea of popping a pill that doesn’t have side effects and may reverse the signs of aging is attractive to many. According to Google Trends, online searches for collagen have steadily increased since 2014. But do they work?

Most research on collagen supplementation is related to skin health. Human studies are lacking but some randomized controlled trials have found that collagen supplements do improve skin elasticity.

However, potential conflicts of interest exist because most if not all of the research on collagen supplements are funded or partially funded by related industries that could benefit from a positive study result, or one or more of the study authors have ties to those industries. This makes it difficult to determine how effective collagen supplementation truly is.

Whilst “industry”, and to an extent the media focus on the skin, I would suggest that bone and joint health should be a far greater concern. If we have an interest in maintaining good bone and joint health (which means we have an interest in remaining mobile, able to live our lives happily and avoiding the fracture clinic), then we need to take some proactive steps.

Collagen in Food

In food, collagen is naturally found only in animal such as meat and fish that contain connective tissue. However, a variety of both animal and plant foods contain materials for collagen production in our own bodies.

There is a lack of research to show that eating collagen can directly benefit skin or joint health. When digested in the stomach, collagen is broken down into amino acids, which are then distributed wherever the body most needs protein. However, many foods that support collagen production are generally recommended as part of a balanced eating plan. Therefore as with most dietary recommendations; simply eating a balanced diet will be absolutely fine and there is no need to start to consume excess quantities of “collagen making super foods”. 

The Role of Exercise

Decreased collagen production can result in reduced size, thickness and resilience of tissues. To what extent this change in structure affects the function and recovery capabilities of connective tissues is not well studied in post menopausal women. But some evidence does suggest a reduction in both strength and recovery capacity. It is not clear exactly how much of this loss is due to age related changes and how much is actually attributable to general reduced fitness and appropriately targeted exercise. There is a general trend for older women to reduce the amount of strength (load bearing) exercise included in their workouts. Similar to bone regeneration, age related loss of function and strength in muscles and tendons is also reduced by incorporating strength exercises within an overall physical exercise programme. The more we stimulate our muscles to repair themselves and “work” the more efficient they will be at it and for longer into our older life.

Whilst there is much scientific evidence supporting the benefit of strength training to stimulate ongoing health and maintenance of tendons and ligaments, independent research specifically in post menopausal women has not been extensively conducted. For this reason, it is difficult to give evidence-based guidelines specifically for menopausal women. Following general strength training guidelines, adjusted to the needs of the individual, represents a safe and pragmatic solution. Resistance training and strength exercise should be a priority for women at this stage of life and most types strength exercise will be beneficial.

Combining reduced collagen production with a lack of strength exercise certainly accelerates the negative physical aspects of ageing. But we can control one of these factors.

Whilst whole body exercise programmes are always a good starting point, there are particular areas of concern for menopausal women that should be given attention. In planning which exercises you will do, you may wish to pay special attention to exercises for the pelvic floor, lateral hip muscles and the feet.

Female Pelvic Floor

Pelvic floor

The pelvic floor is the base of the group of muscles referred to as your ‘core’. These muscles are located in your pelvis and stretch like a hammock from the pubic bone (at the front) to the coccyx or tail-bone (at the back) and from side to side.

The pelvic floor muscles work with your deep abdominal (tummy) and deep back muscles and diaphragm to stabilise and support your spine. They also help control the pressure inside your abdomen to deal with the pushing down force when you lift or strain – such as during exercise.

It is well documented and understood that elasticity of pelvic floor is adversely affected by the decrease in oestrogen at menopause, resulting in a higher incidence of urinary incontinence and pelvic prolapse. The reduced function of the pelvic floor muscles, which can result in stress incontinence, can become a significant barrier to load bearing strength exercise. Women experiencing such symptoms may require specialist assessment and exercise prescription for the pelvic floor. Therefore it would be inappropriate to offer generic advice. But there are exercise based solutions to this that can be considered after consultation with your health professional or GP. The important take away however is to note that pelvic floor dysfunction should not impede you from realising the greater benefits of strength training.

Glute Medius & Minimus are found under the Glute Maximus

Lateral Hip

Pain around the outside of the hip pain appears to be more common in post-menopausal than pre-menopausal women. Dysfunction and pain in this area can have a significant impact on day-to-day function and ability to “live well”. Such pain can often be caused by squashing forces on the main tendons around the hip (this is technically known as Gluteal Tendinopathy). Identifying exercises that target the muscles (and therefore tendons) around the hip should be seen as a priority. The key muscles associated with lateral hip stability are the Gluteus Minimus and Gluteus Medius. Including exercises specifically to improve lateral hip function as part of a lower-body strengthening programme is important to help to maintain function and avoid pain.

Right Planter Aponeurosis Ligament


If there is a lack of research around collagen, then there is an even greater absence of research on foot function in post-menopausal women! However anecdotal evidence suggests a greater instance of Plantar Fasciitis (pain on the bottom of your foot and around the heel and arch). The feet are often neglected in exercise programmes (I guess people don’t get as excited about having amazing feet compared well defined abs!), however specific foot strengthening and mobility exercises can help to keep the feet strong and supple well into older age. This is appropriate to both men and women.

In Conclusion

As both men and women age, it is inevitable that our bodies change. Our metabolism changes and the levels of hormones and enzymes alters. One of the consequences of this is that our body repairs and maintains itself differently and more slowly. These changes are more pronounced in post menopausal women. 

Whilst change is inevitable, we can reduce some of the negative consequences by being selective and targeted about how we use exercise to maintain our mobility, strength and day to dat function. 

Of course I am not suggesting that exercise is the fountain of eternal youth, but there is a clear scientific basis for believing that it has an important role to play in helping us to “live well” for longer. And that can only be a good thing right?


Photo by Limor Zellermayer on Unsplash